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Clinical

Scenario

Bobby and His Mom

Typical Brain Lissencephaly

Bowes et al.

Evaluation

Empirical Precision

  • Concepts are grounded in reality
  • Everyone experiences loss in their life
  • People respond to loss differently
  • Chronic sorrow is considered a normal

response to loss

Generality

Clarity, Simplicity, Parsimony

Derivable Consequences

  • Qualitative research - interviews
  • Burke/NCRCS Chronic Sorrow Questionnaire
  • Kendall Chronic Sorrow Instrument
  • Can be used in many situations
  • chronic disease
  • loss of a loved one
  • child with disability
  • disparity between what is desired

and what is

  • Relevant to all healthcare professionals

as well as other professions

  • Clearly written
  • Simple and easy to understand
  • Concepts were well-defined
  • Could be more concise, some

concepts were repeated

Logical Consistency

  • Logical progression
  • Flows comfortably
  • Consistency throughout article

  • AIM: To explore parents’ experiences of having a child with type I diabetes.
  • SPECIFIC OBJECTIVES:
  • Explore parental emotional adaptation
  • Parental experience of periodic resurgence of grief
  • Emotional adjustment between fathers and mothers.
  • FINDINGS:
  • Successful parental adaptation
  • Unreso;ved grief without endpoint
  • Resurgence of feelings of grief at critical times in childs life
  • Both mothers and fathers reported unmet emotional support from healthcare team

Theory Concepts

  • Chronic sorrow: Periodic recurrence of permanent, pervasive, sadness or other grief-related feelings associated with ongoing disparity resulting from a loss experience

Chronic

Sorrow

Theory

Isaksson et al.

Theory Concepts

  • Loss experience: A significant loss, either actual or symbolic, that may be ongoing with no predictable end or a more circumscribed single loss event
  • AIM: To explore the presence/meaning of chronic sorrow and depression in a large group of persons with multiple sclerosis (MS).
  • Disparity: A gap between the current reality and the desired reality as a result of a loss experience

  • Trigger event (or milestone): A situation, circumstance, or condition that brings the negative disparity resulting from the loss into focus or exacerbates the disparity 
  • Internal management methods: Positive personal coping strategies used to deal with the periodic episodes of chronic sorrow
  • External management methods: Interventions provided by professionals to assist individuals cope with chronic sorrow

SPECIFIC OBJECTIVES:

  • Describe demographic variables and depression in the study group.

  • FINDINGS:
  • 7 themes of loss
  • 62% fulfilled the criteria for chronic sorrow
  • Only 4 of the 38 patients with chronic sorrow had symptoms of being mildly depressed

Research

Review

References

  • Nursing: Part of nursing care involves assessing, strengthening and improving the person’s personal coping mechanisms.
  • Health: Health is facilitated by both internal (personal coping) and external (professional intervention) management methods.

By Lola Ahova,

Allison Luoma

Paula Simpson

  • Person: Affects persons who have experienced a significant loss, whether actual or symbolic.
  • Environment: The environment that a person lives in may from time to time introduce events that throw the disparity created by the loss into sharp focus and trigger the re-experience of the grief-related feelings associated with chronic sorrow.

Chronic Sorrow and Nursing Metaparadigm

Analysis

H. A. Joseph

J. M. Scornaienchi

  • AIM: To increase emergency nurses’ knowledge of chronic sorrow and identify patients who might be experiencing it.
  • AIM: Nurses can plan interventions that recognize chronic sorrow as a normal reaction, promote healthy adaptation, and provide empathetic support.
  • SPECIFIC CONCEPTS:
  • Remove prejudices about drug use, attention-seeking behaviors, and manipulating personalities
  • Abdominal pain is the most common reason for ED visits and has increased 32% over the past 10 years
  • SPECIFIC CONCEPTS:
  • Parents become experts in their child’s condition and in performing complex medical procedures at home. They may need support when coping with the ongoing demands of the child’s illness.
  • Bowes, S., Lowes, L., Warner, J., & Gregory, J. W. (2009). Chronic sorrow in parents of children with type I diabetes. Journal of Advanced Nursing 65(5), 992-1000.
  • Eakes, G. G. (2009). Chronic sorrow. In S. J. Peterson & Bredow, T. S, Middle range theories: Application to nursing research, Philadelphia, PA: Wolters Kluwer/ Lippincott Williams & Wilkins. Pp. 149-159.
  • Isaksson, A., Gunnarsson L., & Ahlstrom, G. (2007). The presence and meaning of chronic sorrow in patients with multiple sclerosis. Journal of Nursing and Healthcare of Chronic Illness 16(11), 315-324.
  • Joseph, H. (2012). Recognizing Chronic Sorrow in the Habitual ED Patient. Journal of Emergency Nursing 38(6), 539-540.
  • Scornaienchi, J. M. (2003). Chronic Sorrow: One Mother’s Experience With Two Children With Lissencephaly. Journal of Pediatric Health Care 17(6), 290-294.

  • FINDINGS:
  • This was a personal account of an RN whose mother was an alcoholic and unattentive parent; difficult and strained relationship.
  • Nurses were instrumental in providing her with effective coping skills to include journaling, counseling and exercise.
  • FINDINGS:
  • Identified coping mechanisms being used by the parents.
  • Recognized all the positive things their child(ren) have brought to their lives.
  • Effective internal and external management methods increase comfort and serve to prolong the time between episodes of chronic sorrow triggered by milestone events. The reverse is true when management methods are ineffective
  • Chronic sorrow is not pathological. Rather it is a normal response to the ongoing disparity or gap created by a loss experience.

  • Normalization of the loss experience does not diminish the validity or intensity of the grief-related feelings associated with the loss experience.

  • Chronic sorrow continues as long as the disparity formed by a loss experience remains. i.e. The lack of closure sets the stage for grief to be re-experienced periodically
  • Improve understanding of parent’s long-term emotional responses.

  • Provide appropriate and timely support at critical times.

  • Provide psychological support and promote a sense of hope and control.

  • Teach effective coping mechanisms and techniques

Theory Propositions

Theory Assumptions

Nursing

Practice

  • Recognize that chronic sorrow is a normal response and that depression and chronic sorrow can occur together.

  • Distinguish chronic sorrow from depression

  • Listen and have an open, honest line of communication; believe the patients; provide a supportive environment; and offer reassurance.

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